<form action="index.php?route=payment/sagepay_us/send" method="post">
	<h2><?php echo $text_credit_card; ?></h2>
	<?php if(isset($errors)) echo '<span class="s-error">'. $errors .'</span>';?>
	<ul class="form">
		<li>
			<label for="cc_owner"><?php echo $entry_cc_owner; ?></label>
			<input type="text" name="cc_owner" value="" />
		</li>
		<li>
			<label for="cc_number"><?php echo $entry_cc_number; ?></label>
			<input type="text" name="cc_number" value="" />
		</li>
   		<li>
			<label for="cc_expire_date_month"><?php echo $entry_cc_expire_date; ?></label>
			<select name="cc_expire_date_month">
			<?php foreach ($months as $month) { ?>
			<option value="<?php echo $month['value']; ?>"><?php echo $month['text']; ?></option>
			<?php } ?>
			</select>
			<select name="cc_expire_date_year">
			<?php foreach ($year_expire as $year) { ?>
			<option value="<?php echo $year['value']; ?>"><?php echo $year['text']; ?></option>
			<?php } ?>
			</select>
		</li>
		<li>
			<label for="cc_cvv2"><?php echo $entry_cc_cvv2; ?></label>
			<input type="text" name="cc_cvv2" value="" size="3" />
		</li>
  	</ul>
	<input type="submit" value="<?php echo $button_confirm; ?>"/>
</form>